Development of a large spontaneous pneumothorax after recovery from mild COVID-19 infection

Abstract

A previously healthy 37-year-old man presented with fevers and myalgias for a week with a minimal dry cough. Initial SARS-CoV-2 nasopharyngeal testing was negative, but in light of high community prevalence, he was diagnosed with COVID-19, treated with supportive care and self-quarantined at home. Three days after resolution of all symptoms, he developed sudden onset chest pain. Chest imaging revealed a large right-sided pneumothorax and patchy subpleural ground glass opacities. IgM and IgG antibodies for SARS-CoV-2 were positive. His pneumothorax resolved after placement of a small-bore chest tube, which was removed after 2 days.This case demonstrates that patients with COVID-19 can develop a significant pulmonary complication, a large pneumothorax, despite only minimal lower respiratory tract symptoms and after resolution of the original illness. Medical professionals should consider development of a pneumothorax in patients who have recovered from COVID-19 and present with new respiratory symptoms.

Secondary Spontaneous Pneumothorax in a COVID-19 Recovered Patient

“…There are increased reports of spontaneous pneumothorax in patients within the literature, which were thought to be an uncommon sequela of the infection. However, the development of the complication is not well understood, with some sources citing the virus as the cause while others are implicating pneumonia, poor intubation technique, or barotrauma [4][5][6][7]. In cases without proof of barotrauma, a secondary spontaneous pneumothorax may develop in the context of COVID-19 in 1% of patients [8].…”

Spontaneous pneumothorax as a delayed complication after recovery from COVID-19

“… 1 8 13 A review of the literature 1 3–5 9 13 shows that pneumothorax is an uncommon complication that occurs predominantly during active SARS-CoV-2 infection and it is scarcely reported after the recovery from the disease. 8 12 14 15 The relevance of this case lies in the absence of major risk factors for spontaneous pneumothorax in our patient’s medical history: during his COVID-19 infection he had not been intubated and on his access in the ER the RT-PCR swab was negative. This means that even after the infection is overcome, severe complications are still possible.…”

“…1 5 Spontaneous pneumothorax is reported in only 1% of cases, 5 7 with a higher prevalence (88%) in men. [8][9][10] According to some authors, 5 8-11 the main cause of pneumothorax in patients with COVID-19 are cystic lesions, which could occur as a result of barotrauma due to mechanical ventilation, and alveolar damage due to coughing, which causes an increase in chest pressure and ultimately an alveolar breach. 1 3 5 8 12 Moreover, COVID-19 pneumonia results in alveolar swelling, inflammation of alveolar septa, fibrosis, giant bullae 5 9 11 13 and subpleural infiltrates.…”

“… 1 5 Spontaneous pneumothorax is reported in only 1% of cases, 5 7 with a higher prevalence (88%) in men. 8–10 …”

“… 1 3 5 8 12 Moreover, COVID-19 pneumonia results in alveolar swelling, inflammation of alveolar septa, fibrosis, giant bullae 5 9 11 13 and subpleural infiltrates. 8 All of these conditions contribute to parenchymal damage with possible alveolar rupture and pneumothorax. 1 8 13 A review of the literature 1 3–5 9 13 shows that pneumothorax is an uncommon complication that occurs predominantly during active SARS-CoV-2 infection and it is scarcely reported after the recovery from the disease.…”